Complications After Gynecologic and Obstetric Procedures: A Pictorial Review

https://doi.org/10.1067/j.cpradiol.2017.06.006Get rights and content

Gynecologic and obstetric procedures require careful dissection in to high real-estate regions in the pelvis and abdomen where many structures lie in close proximity: the urinary bladder, ureter, and bowel. Damage to one of these structures can cause significant morbidity. Recognition of the patient who has an acute complication of gynecologic or obstetric surgery on imaging can precipitate quick and effective medical management. Imaging can appropriately diagnose the underlying problem and provide critical information for the clinical team. In this review, we present acute complications of gynecologic and obstetric procedures and their imaging appearances.

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Complications After Gynecologic and Obstetric Procedures: A Pictorial Review

Gynecologic and obstetric surgeries carry a risk of iatrogenic injury to structures near the uterus and ovaries, including the urinary bladder, ureter, and bowel (Fig 1). Damage to any one of these structures can cause significant morbidity, a prolonged hospital stay, and potentially mortality if diagnosis is delayed. Many times, imaging is the first diagnostic tool to raise the suspicion of iatrogenic injury as 1 in 4 complications are not diagnosed at the time of surgical intervention.1

Ureteral Injury

The ureters are long tubular structures that measure 25-30 cm in length and are separated into abdominal and pelvic portions each measuring 12-15 cm long. At the pelvic brim, the ureters course along the medial aspect of the psoas muscles and enter the pelvis at the level of the common iliac artery bifurcations. In the pelvis, the ureters lie posterior to the uterine artery (the so-called water under the bridge), anterior to the psoas muscles and iliac vessels, and along the lateral aspects of

Gastrointestinal Injury

The course of the gastrointestinal tract brings the small and large bowel into close approximation with the uterus and cervix. Although injury to the bowel during gynecologic and obstetric procedures is a well-described complication, only one-third of injuries to the bowel are detected at the time of surgery.16 Therefore, the radiologist has a critical role in the diagnosis of bowel injury for patients with persistent abdominal pain after obstetric or gynecologic procedures. Timely diagnosis is

Uterine Artery Injury

The anterior divisions of the internal iliac arteries supply the viscera of the pelvis including the uterus, cervix, and vagina. The uterine artery arises most commonly from the medial aspect of the internal iliac artery, penetrating the broad ligament at the superior angle of the uterus, before dividing into its terminal branches that supply blood flow to the fallopian tube along with the ovarian artery branches. However, there is substantial variability in the course of the uterine artery,

Intrauterine Devices

Intrauterine devices (IUD) come in 2 broad categories, hormonal IUD and copper-containing IUD. As a whole, the IUD is considered one of the most effective ways of preventing pregnancy: hormonal IUDs are 98%-99% effective. In addition, IUDs are an extremely common form of contraception, owing to its effectiveness, relative low frequency of replacement, and small risk of complications.27

Uterine perforation is a rare, but well-described complication of IUD placement. The reported incidence of

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  • Given the nature of this review article, an appropriate institutional review board was not needed. This review article was based on an education exhibit presented at RSNA 2015. This article has not been previously published. There are no disclosures for funding for any of the authors.

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